Driver Application for Employment:

Size: px
Start display at page:

Download "Driver Application for Employment:"

Transcription

1 *This Application must be filled out completely, in Blue or Black ink and in your own handwriting. If an item does not apply to you, please write N/A. Before you complete the application know the information your provide in accordance with Part (b)(1-10) shall be used and your previous employers contacted for the purposes of investigating your Safety Performance History as required in (d) & (e). Applicant s Name: Driver Application for Employment: (Last Name) (First Name) (Middle Initial) (Date of Application) Current Address: (Current Street Address) (City) (State) (Zip Code) *If at the above address less than three (3) years, list below all residences for the past three years. Attach a separate sheet if necessary. Previous Addresses: (Street Address) (City) (State) (Zip Code) (How long? Yrs./Mo.) (Street Address) (City) (State) (Zip Code) (How long? Yrs./Mo.) (Street Address) (City) (State) (Zip Code) (How long? Yrs./Mo.) (Street Address) (City) (State) (Zip Code) (How long? Yrs./Mo.) Home Phone: ( ) Cell Phone: ( ) Address: Fax Number: ( ) Date of Birth: Social Security Number: Desired Position: Position Applying For: State: (Transport or Frac Refill) (City & State of Operation) What shifts are you able to work: Salary Desired:

2 Commercial Motor Vehicle Experience: Class of Equipment: Years of Operation: Approximate Miles: Type of Equipment: (Van, Flatbed, Tankwagon, etc ) Tanker (80,000 GVWR): Straight Truck: Twin Trailers (LCV s): Other: Driver s License Information: Driver s License Number: Issuing State: License Class (A/B): Endorsements: CDL Issue Date: CDL Expiration Date: Do you have any restrictions on your license? If yes, please explain: Has your license, or permit to drive or privilege to operate a motor vehicle ever been denied, revoked, or suspended? If yes, please provide a statement detailing the facts and circumstances Accident History: (Please provide accidents for the last three (3) years. Attach additional page(s) if necessary.) Date of Incident: Type of Accident: (Head-on, Rear-end, Rollover, etc ) Number of Fatalities Number of Injuries Hazardous Materials Spill? YES NO YES NO YES NO

3 Commercial Motor Vehicle Traffic Convictions and Forfeitures: (List any for the last three (3) years from the date of the application in which you were convicted of or forfeited bond or collateral do not list parking tickets.) Date: Offense: Location: (City, State) Type of Vehicle Operated: Penalty: Personal Information: Are you a citizen of the United States? If hired, can you provide proof? Have you ever been convicted of a felony? If yes, please explain: Did you graduate High School? If no, do you have a GED? Did you graduate Truck Driving School? If yes, name of Truck Driving School? Have you ever served in the U.S. Military Service? From/To? What branch of service? (Army, Navy, Marine, etc ) Final Rank? Have you ever worked for Chemoil before? If yes, when? Were you referred to Chemoil by a Chemoil Employee? If yes, employee name? This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I further understand that any misleading, incorrect, or omitted statements or information can render this application void and if employed would be just cause for termination. X (Applicant Signature) X (Date)

4 Work History: (List current or most recent employer first, then all previous employers for the last 10 years. Account for all periods of unemployment or self-employment. (Your application will not be processed without 10 years work history.) Current or Last Employer Name: (Address) (City) (State & Zip Code) Job Title: Supervisor Name: Reason for Leaving: Major Job Duties: Dates of Service From: To: Wages: Was this position subject to FMCSR Rules? Yes or No Was this a Safety Sensitive Position? Yes or No Phone Number: ( ) Contact Name: Previous Employer Name: (Address) (City) (State & Zip Code) Job Title: Supervisor Name: Reason for Leaving: Major Job Duties: Dates of Service From: To: Wages: Was this position subject to FMCSR Rules? Yes or No Was this a Safety Sensitive Position? Yes or No Phone Number: ( ) Contact Name:

5 Previous Employer Name: (Address) (City) (State & Zip Code) Job Title: Supervisor Name: Reason for Leaving: Major Job Duties: Dates of Service From: To: Wages: Was this position subject to FMCSR Rules? Yes or No Was this a Safety Sensitive Position? Yes or No Phone Number: ( ) Contact Name: Previous Employer Name: (Address) (City) (State & Zip Code) Job Title: Supervisor Name: Reason for Leaving: Major Job Duties: Dates of Service From: To: Wages: Was this position subject to FMCSR Rules? Yes or No Was this a Safety Sensitive Position? Yes or No Phone Number: ( ) Contact Name:

6 Previous Employer Name: (Address) (City) (State & Zip Code) Job Title: Supervisor Name: Reason for Leaving: Major Job Duties: Dates of Service From: To: Wages: Was this position subject to FMCSR Rules? Yes or No Was this a Safety Sensitive Position? Yes or No Phone Number: ( ) Contact Name: Motor Vehicle Record Release: I hereby authorize you to release my Motor Vehicle Record (MVR) to Chemoil Energy pursuant to the Federal Motor Carrier Safety Regulations, parts (a)(1) and (a)(b)(1) and (2). You are released from any and all liability which may result from furnishing such information. I further understand this information will be used for permissible purpose and will not be disclosed or transferred to other parties not affiliated with Chemoil Energy. This is a consumer report and the information obtained will not be used in violation of any federal, state, or equal opportunity law or regulation. Upon receipt and review of the report; and before taking any adverse action based in whole or in part of the report; Chemoil Energy will provide the applicant a copy of the report and the summary of consumer rights as provided with the report by the consumer reporting agency. Applicant Signature: X Date: X

7 FMCSA Pre-Employment Screening (PSP) Release: 1. In connection with your application for employment with Chemoil Energy ( Prospective Employer ), it may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). When the application for employment is submitted in person, if the Prospective Employer uses and information it obtains from FMCCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three (3) business days of taking adverse action oral, written, or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address and toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of a driver record from the Prospective Employer who procured the report, then, within three (3) business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. The Prospective Employer cannot obtain background reports from FMCSA unless you consent in writing. If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: 2. I authorize Chemoil Energy ( Prospective Employer ) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am consenting to the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee. 3. I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to If I am challenging crash or inspection information reported by a State, FMCSA cannot change or correct the data. I understand my request will be forwarded by the DataQ s system to the appropriate agency for adjudication. 4. Please Note: Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report. I have read the above Notice Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this consent form, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above. Driver s Name (Printed): Driver s Signature: Date:

8 Release of Information Form 49 CFR Part 40 Drug and Alcohol Testing Section I. To be completed by the new employer, signed by the employee and transmitted to the previous employer: Employee Printed or Typed Name: Employee SS or ID Number: I hereby authorize release of information from my Department of Transportation regulated drug and alcohol testing records by my previous employer, listed in Section 1-B, to the employer listed in Section 1-A. This release is in accordance with DOT Regulation 49 CFR Part 40, Section I understand that information to be released in Section II-A by my previous employer, is limited to the following DOT-Regulated testing items: 1. Alcohol test with a result of 0.04 or higher; 2. Verified positive drug tests; 3. Refusals to be tested; 4. Other violations of DOT agency drug and alcohol testing regulations; 5. Information obtained from previous employers of drug and alcohol rule violation; 6. Documentation, if any, of completion of the return-to-duty process following a rule violation. Employee Signature: I-A. New Employer Name: Date: As Requested By: Address: Phone #: Fax #: I-B. Previous Employer Name: Address: Phone #: Fax #: Section II. To be completed by the previous employer and transmitted by mail or fax to the new employer: II-A. In the two years prior to the date of the employee s signature (in Section I), for DOT-regulated testing- 1. Did the employee have alcohol tests with a result of 0.04 higher? YES NO 2. Did the employee have verified positive drug tests? YES NO 3. Did the employee refuse to be tested? YES NO 4. Did the employee have other violations of DOT Agency drug and alcohol testing regulations? YES NO 5. Did a previous employer report a drug and alcohol rule violation to you? YES NO 6. If you answered yes" to any of the above items, did the employee complete the return-to-duty process? YES NO II-B. Name of person providing information in Section II-A: Title: Phone#: Date:

9 Application Authorization to Release Safety Performance History (Per 49 CFR Parts and ) Name of Applicant: SSN/ID Number: Date of Birth: 4 East Sheridan, Suite 400 Applicant Name: I,, do hereby authorize you to release the following information to Shield Screening, for the purposes of investigation as required by Section of the Federal Motor Carrier Safety Regulations. Check this box if you have performed DOT Functions in the past 3 years. Check this box if you have tested positive, or refused a test, on any DOT pre-employment drug or alcohol test administered by an employer who did not hire you during the past two years. Applicant Signature: Date: To be completed by Previous Employer Previous Employer: Phone Number: Address: Fax Number: City, State Zip: Job title of the above name person: From: To: In accordance with Section , we are obligated to request the information below from all previous employers of the applicant the employed him/her to operate a commercial motor vehicle within the 3 years preceding the date above. Please complete the information below and return to us within 30 days, as required by Section (g). Please phone/fax/mail the following information to: Shield Screening 6810 E. 121 st St Bixby, OK Ph: F: Safety Performance History: To be completed by Previous Employer Did he/she driver a commercial motor vehicle for you? YES NO If yes, what type? Straight Truck Tractor-Semi Trailer Doubles/Triples Cargo Tank Bus Other(specify) Reason for leaving your company: Discharged Resignation Lay Off Military Duty Check here if NO safety performance History to report, sign below and return. Accidents: Date: Location: # of Injuries: HAZMAT: Any other remarks: Signature: Title: Date:

10 Motor Carrier Instructions: The requirements in Part 383 apply to every driver who operates in intrastate, interstate, or foreign commerce and operates a vehicle weighing 26,001 pounds or more, can transport more than fifteen (15) people, or transports hazardous materials that require placarding. The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing 10,001 pounds or more, can transport more than fifteen (15) people, or transports hazardous materials that require placarding. Driver Requirements: Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain certain driver license requirements that you as a driver must comply with, including the following: 1. POSSESS ONLY ONE LICENSE: You, as a commercial vehicle driver, may not possess more than one motor vehicle operator s license. 2. NOTIFICATION OF LICENSE SUSPENSION, REVOCATION, AND/OR CANCELLATION: Sec (b) (2) and of the Federal Motor Carrier Safety Regulations require that you notify your employer the NEXT BUSINESS DAY of any revocation or suspension of your driver s license. In addition, Sec requires that any time you are convicted of violating a state or local traffic law (other than parking), you must report it within 30 days to: 1) your employing motor carrier, and 2) the state that issued your license (if the violation occurs in a state other than the one which issued your license). The notification to both the employer and state must be in writing. 3. CDL DOMICILE REQUIREMENT: Sec (a)(2) requires that your commercial driver s license be issued by your legal state of domicile, where you have your true, fixed, and permanent home and principal residence and to which you have the intention of returning whenever you are absent. If you establish a new domicile in another state, you must apply to transfer your CDL within 30 days. The following License is the only one I possess: Certification of Compliance with Driver License Requirements Driver License Number: State: Expiration Date: DRIVER CERTIFICATION: I certify that I have read and understand the above requirements. Driver s Name (Printed): Driver s Signature: Date: Notes:

11 Commercial Driver License Self-Certification Driver s Name (First, MI, Last): Driver s License Number: Effective January 31 st, 2012, the Federal Motor Carrier Safety Administration (FMCSA) requires that all Commercial Driver License holders (CDL) self-certify to the motor carrier what type of operation they will perform. This self-certification is required and found in Part (a)(1)(ii) and (g). The Department of Transportation, (DOT and FMCSA) require that all licensed CDL holders obtain a copy of their medical examiners certificate when they are renewing their CDL. Additional documentation for CDL renewal is also required and that information can be found in Part (d). I certify my commercial transportation is (please check only one (1) box): 1. Non-Excepted Interstate (NI): I certify that I operate or expect to operate in interstate commerce, is both subject to and meets the qualification requirements under 49CFR Part 391, and is required to obtain a medical examiner s certificate by 49 CFR Excepted Interstate (EI): I certify that I operate or expect to operate in interstate commerce, but engage exclusively in transportation or operations excepted under 49 CFR 390.3(f), 391.2, , or from all or parts of the qualification requirements of 49 CFR Part 391, and is therefore not required to obtain a medical examiner s certificate by 49 CFR Non-Excepted Intrastate (NA): I certify that I operate only in intrastate commerce and therefore am subject to State driver qualification requirements. 4. Excepted Intrastate (EA): I certify that I operate in intrastate commerce, but engage exclusively in transportation or operations excepted from all or parts of the State driver qualification requirements. Driver s Signature: X Date: X

12 Hours of On-Duty Statement INSTRUCTIONS: Motor carriers when using a driver for the first time shall obtain, from the Driver, a signed statement giving the total time on-duty during the immediately preceding seven (7) days and time at which such Driver was last relieved from duty prior to beginning work for such Carrier. (Reference Rule 395.8(j)(2) Federal Motor Carrier Safety Regulations) NOTE: Hours for any compensated work during the preceding seven (7) days, including work for a non-motor carrier entity, must be recorded on this form. Driver Name (First, MI, Last): Social Security Number: Driver s License Number: State: Class: Endorsements: Day 1 Day Ago Date 2 Days Ago 3 Days Ago 4 Days Ago 5 Days Ago 6 Days Ago 7 Days Ago Total Hours Hours Worked I hereby certify that the information given above is correct to the best of my knowledge and belief, and that I was last relieved from work at: AM Time PM ON: Day Month Year Driver s Signature: X Date: X Driver Certification for other compensated work: INSTRUCTIONS: When employed by a motor carrier, a driver must report to the carrier all on-duty time including time working for other employers. The definition of on-duty time found in Section 395.2, paragraphs (8) and (9) of the Federal Motor Carrier Safety Regulations includes time performing any other work in the capacity of, or in the employment or service of, a common, contract, or private motor carrier, also performing any compensated work for any non-motor carrier entity. Are you currently working for another employer? YES NO At this time, do you intend to work for another employer while still employed by this Company? YES NO I hereby certify that the information given above is true and I understand that once I become employed by Chemoil Energy, if I begin working for any additional employer(s) for compensation that I must inform Chemoil Energy immediately, in writing, or such intended employment activity. Driver s Signature: X Date: X Company Representative: X Date: X

13

DRIVER S APPLICATION

DRIVER S APPLICATION DRIVER S APPLICATION Applicant Name (print name) Date of Application Company: Hampton Jitney, Inc., 395 County Road 39A, Suite 6, Southampton, NY 11968 Hampton Jitney, Inc., 253 Edwards Avenue, Calverton,

More information

DRIVER'S APPLICATION FOR EMPLOYMENT

DRIVER'S APPLICATION FOR EMPLOYMENT DRIVER'S APPLICATION FOR EMPLOYMENT Applicant Name Date of Application Application for: Doug Bradley Trucking, Inc. 680 E. Water Well Rd. Salina, KS 67401 In compliance with Federal and State equal employment

More information

Please answer all questions. If the answer to any question is "No" or "None", do not leave blank, but write "No" or "None.

Please answer all questions. If the answer to any question is No or None, do not leave blank, but write No or None. Application for Qualification W.&A. Company: W & A Distribution Services Inc. Address: DISTRIBUTION SERVICES, INC. 1618 Summit Dr. Ft. Atkinson, WI. 53538 P.O. BOX 309 FORT ATKINSON, WI 53538 The purpose

More information

2505 Industrial Park Rd Van Buren, AR Current Address: (Street) (City) (State) (Zip)

2505 Industrial Park Rd Van Buren, AR Current Address: (Street) (City) (State) (Zip) 2505 Industrial Park Rd Van Buren, AR 72956 479-474-5600 Name: ( (First) (Middle) (Last) (Phone) ) Current (Street) (City) (State) (Zip) If at above address for less than three years, list below all residences

More information

CDL DRIVER S APPLICATION FOR EMPLOYMENT

CDL DRIVER S APPLICATION FOR EMPLOYMENT CDL DRIVER S APPLICATION FOR EMPLOYMENT Applicant Name: Date: 10 Industrial Highway M.S. 61 Lester, PA 19113 Phone: (610) 521-7474 Fax: (610) 521-8507 Driver Acknowledgement I authorize KL Chempak, Inc.

More information

C&J Bus Lines. Driver Employment Application

C&J Bus Lines. Driver Employment Application C&J Bus Lines Driver Employment Application Applicant Name: Driver Application for Employment _ Home Phone Cell Phone Email Address We consider applicants for all positions on the basis of qualifications

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT COMPANY RITEWAY EXPRESS APPLICATION FOR EMPLOYMENT, AND CODE BREVARD, NC 28712 (FIRST) (MIDDLE) (MAIDEN, IF ANY) (LAST) (STREET) () ( & CODE) OF BIRTH PREVIOUS THREE YEARS RESIDENCY (STREET) () ( & CODE)

More information

AARMAC TRANSPORT, INC nd Ave SW MINOT, ND 58701

AARMAC TRANSPORT, INC nd Ave SW MINOT, ND 58701 AARMAC TRANSPORT, INC. 1509 2nd Ave SW MINOT, ND 58701 Driver Application for Employment You are advised that the information you provide in this application may be used, and your prior employers will

More information

APPLICATION FOR CLASS A CDL DRIVER

APPLICATION FOR CLASS A CDL DRIVER 1.877.ROMEX.20 www.goromex.com 1.800.925.1553 Fax info@romextransport.com APPLICATION FOR CLASS A CDL DRIVER Date of application: / / Last Name: First Name: MI: Address: How Long? City: State: Zip code:

More information

DRIVER QUALIFICATION FILE CHECK LIST

DRIVER QUALIFICATION FILE CHECK LIST DRIVER QUALIFICATION FILE CHECK LIST DRIVER APPLICATION FOR EMPLOYMENT INQUIRY TO PREVIOUS EMPLOYERS (3 YEARS) INQUIRY TO STATE AGENCIES OR MVR MEDICAL EXAMINER S CERTIFICATE* (MEDICAL WAIVER, IF ISSUED)

More information

This application must be filled out completely and accurately to be considered. EMPLOYMENT APPLICATION FOR CONTRACTOR DRIVERS

This application must be filled out completely and accurately to be considered. EMPLOYMENT APPLICATION FOR CONTRACTOR DRIVERS Please Print Last Here: SYNERGY RV TRANSPORT I N C O R P O R A T E D 2448 E Kercher Rd, Goshen, IN 46526 Recruiting Phone: 574.533.0001 Recruiting Fax: 1.888.270.3693 www.synergyrvtransport.com EMPLOYMENT

More information

CMV DRIVER S QUALIFICATION APPLICATION (per 49 CFR )

CMV DRIVER S QUALIFICATION APPLICATION (per 49 CFR ) CMV DRIVER S QUALIFICATION APPLICATION (per 49 CFR 391.21) Date of Application Medallion Transport & Logistics, LLC Medallion International, LLC 307 Oates Road, Ste. H 307 Oates Road, Ste. H Mooresville,

More information

PLAINFIELD TRUCKING,Inc.

PLAINFIELD TRUCKING,Inc. APPLICATION FOR AUTHORIZATION TO DRIVE COMPANY DRIVER PLAINFIELD TRUCKING,Inc. P.O. Box 306 Plainfield, WI 54966 office: 715-335-6375 fax: 715-335-6011 Please print plainly in ink and all blanks must be

More information

DRIVER APPLICATION FOR EMPLOYMENT

DRIVER APPLICATION FOR EMPLOYMENT DRIVER APPLICATION FOR EMPLOYMENT PERSONAL DATA NAME LAST FIRST MIDDLE APPLICATION DATE CURRENT STREET UNIT # CITY STATE ZIP CODE HOW LONG: (IF AT THE CURRENT LESS THAN THREE YEARS, PROVIDE ADDITIONAL

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT COMPANY RITEWAY EXPRESS APPLICATION FOR EMPLOYMENT CITY, AND ZIP CODE BREVARD, NC 28712 NAME (FIRST) (MIDDLE) (MAIDEN NAME, IF ANY) (LAST) ADDRESS (STREET) (CITY) ( & ZIP CODE) OF BIRTH PREVIOUS THREE

More information

Personal Information Office use only Recruiting Terminal ID: Domicile Terminal Contact Information CDL Information Endorsements: Driver Information

Personal Information Office use only Recruiting Terminal ID: Domicile Terminal Contact Information CDL Information Endorsements: Driver Information Personal Information Office use only Recruiting Terminal ID: Domicile Terminal Contact Information Full Name: 1: 2: : : : Day : Night : Email: SSN: How did you hear about us? Referred by: CDL Information

More information

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application

More information

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application

More information

Please indicate which area(s) you are interested in: Terminal Location: If you have any questions please feel free to contact me.

Please indicate which area(s) you are interested in: Terminal Location: If you have any questions please feel free to contact me. Ali Saley, Recruiter PO Box 205 W2197 County Rd B West Salem, WI 54669-0205 Dear Applicant, Thank you for your interest in our company. Included with this application are four release forms. Please remember

More information

APPLICATION FOR QUALIFICATION

APPLICATION FOR QUALIFICATION RETURN THIS FORM BY: EMAIL: tara.obrist@behlenmfg.com FAX: 402 563 7283 MAIL: PO BOX 569 COLUMBUS, NE 68602 APPLICATION FOR QUALIFICATION BMC Transportation 4025 E. 23 rd Street Columbus, NE 68602-0569

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT APPLICATION FOR EMPLOYMENT Applicant Name (Print) Date of Application Company Delco Transport Inc. / The DeLong Co., Inc. Address P. O. Box 552 City Clinton State WI Zip 53525 In compliance with Federal

More information

PACESETTER TRUCKING CO.

PACESETTER TRUCKING CO. PACESETTER TRUCKING CO. DRIVER S APPLICATION P.O. Box 9636 918-245-7227 for OWNER OPERAR or EMPLOYMENT Tulsa, OK 74157 800-725-3384 918-245-7253 FAX Position Applied For Date of Application LAST FIRST

More information

CONTRACTOR APPLICATION

CONTRACTOR APPLICATION Horizon Freight System, Inc. 8777 Rockside Road Cleveland, OH 44125 800-480-6829, ext. 160 801-206-3970 fax applications@horizonfreightsystem.com 1 of 5 CONTRACTOR APPLICATION In compliance with Federal

More information

SPINNAKER OILFIELD SERVICES COMPANY LLC

SPINNAKER OILFIELD SERVICES COMPANY LLC SPINNAKER OILFIELD SERVICES COMPANY LLC 3675 S ALFADALE RD, EL RENO, OK 73036 careers@spinnakeroil.com APPLICATION FOR EMPLOYEMENT (DRIVER S ADDENDUM) YOU MUST ANSWER EVERY QUESTION. IF ANY QUESTIONS DO

More information

APPLICATION FOR QUALIFICATION

APPLICATION FOR QUALIFICATION APPLICATION FOR QUALIFICATION Company Wynne Transport Service, Inc. 2222 N 11 th Street City Omaha State NE Zip 68110 The purpose of this application is to determine whether or not that applicant is qualified

More information

TSI TRUCKING, LLC 1618 Fabricon Blvd. Jeffersonville, IN DRIVER'S APPLICATION FOR EMPLOYMENT. Applicant name: Date of application

TSI TRUCKING, LLC 1618 Fabricon Blvd. Jeffersonville, IN DRIVER'S APPLICATION FOR EMPLOYMENT. Applicant name: Date of application TSI TRUCKING, LLC 1618 Fabricon Blvd. Jeffersonville, IN 47130 DRIVER'S APPLICATION FOR EMPLOYMENT Applicant name: Date of application In compliance with Federal and State equal employment opportunity

More information

PRE-EMPLOYMENT URINALYSIS NOTIFICATION

PRE-EMPLOYMENT URINALYSIS NOTIFICATION PRE-EMPLOYMENT URINALYSIS NOTIFICATION The Federal Motor Carrier Safety Regulations, Section 391.103 pre-employment testing requirements, apply to driver-applicants of this company. 391.103 Pre-employment

More information

P.O. BOX LITTLE ROCK, AR FAX #: HIRERIGHT CUSTOMER #: MAVTRAN

P.O. BOX LITTLE ROCK, AR FAX #: HIRERIGHT CUSTOMER #: MAVTRAN P.O. BOX 16173 LITTLE ROCK, AR 72231 800-289-1100 FAX #: 501-955-4256 recruiting@maverickusa.com HIRERIGHT CUSTOMER #: MAVTRAN IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

More information

62 Leversee Road, Troy, NY Phone: Fax: PLEASE READ CAREFULLY

62 Leversee Road, Troy, NY Phone: Fax: PLEASE READ CAREFULLY 62 Leversee Road, Troy, NY 12182 Phone: 518-235-5531 Fax: 518-235-1064 PLEASE READ CAREFULLY Warren W. Fane, Inc. is an equal opportunity employer that provides its employees with competitive wages and

More information

Application for Independent Contractor Owner-Operator

Application for Independent Contractor Owner-Operator 3720 River Rd. Suite 100 Franklin Park, IL 60131 (847) 260-4151 phone (847) 789-8684 fax www.rmtrucking.com email: hr@rmtrucking.com 5120 S. International Drive Cudahy, WI 53110 (414) 294-5800 phone (414)

More information

Monson & Sons, Inc TH STREET NW BRITT, IA PH: FAX:

Monson & Sons, Inc TH STREET NW BRITT, IA PH: FAX: Monson & Sons, Inc. 216 5 TH STREET NW BRITT, IA 50423 PH: 641-843-4272 FAX: 641-843-3519 www.monsonandsons.com Thank you for your interest in Monson & Sons, Inc. The following information is provided

More information

DRIVER APPLICATION FOR EMPLOYMENT

DRIVER APPLICATION FOR EMPLOYMENT ELITE TRANSPORTATION, LLC 200 W DOUGLAS, SUITE 520 WICHITA, KS 67202 DRIVER APPLICATION FOR EMPLOYMENT Applicant (Print) : Date: TO BE READ AND SIGNED BY APPLICANT I understand the information I provide

More information

GENERAL EDUCATION EXPERIENCE AND QUALIFICATIONS DRIVING POSITIONS LIST ALL DRIVER'S LICENSES YOU HA VE HELD IN THE PAST THREE (3) YEARS

GENERAL EDUCATION EXPERIENCE AND QUALIFICATIONS DRIVING POSITIONS LIST ALL DRIVER'S LICENSES YOU HA VE HELD IN THE PAST THREE (3) YEARS GENERAL Have you served in the U.S. Armed Forces? Branch from / to / Rank at Discharge----- Date of Discharge or Release Have you ever been bonded? Name of Bonding Company In order for you to drive a company

More information

Brown Trucking Company COMPANY DRIVER APPLICATION 6908 Chapman Road Lithonia, GA Fax: (770)

Brown Trucking Company COMPANY DRIVER APPLICATION 6908 Chapman Road Lithonia, GA Fax: (770) Brown Trucking Company COMPANY DRIVER APPLICATION 6908 Chapman Road Lithonia, GA 30058 Fax: (770)408-0821 In compliance with Federal and State Equal Opportunity laws, qualified applicants are considered

More information

SandBox Transportation, LLC

SandBox Transportation, LLC SandBox Transportation, LLC DRIVER APPLICATION Please fax back to 713-999-0429 or email back to hr@sandboxlogistics.com For further questions call 832-558-1955 Dear Applicant, Please put 10 years of employment

More information

Employment Application

Employment Application 750 TECHNOLOGY DRIVE GOLETA, CA 93117 PHONE: (805) 964-7759 FAX: (805) 683-0307 WWW.SBAIRBUS.COM Employment Application To Applicant: We deeply appreciate your interest and assure you that we are sincerely

More information

321 Fitzgerald Industrial Drive, Sparta, TN Phone Fax Applicant Name Date of Application (Please Print)

321 Fitzgerald Industrial Drive, Sparta, TN Phone Fax Applicant Name Date of Application (Please Print) 321 Fitzgerald Industrial Drive, Sparta, TN 38583 Phone 931.854.1100 Fax 931.854.1131 Applicant Name Date of Application (Please Print) In compliance with Federal and State equal employment opportunity

More information

DRIVER S APPLICATION FOR EMPLOYMENT

DRIVER S APPLICATION FOR EMPLOYMENT DRIVER S APPLICATION FOR EMPLOYMENT APPLICANT NAME OF APPLICATION (please print) BRITTANY TRUCKING COMPANY, INC. 515 Montgomery Avenue, Suite 101 New Castle, PA 16102 Phone: 724-658-6692 / Fax: 724-856-3715

More information

Employment Application

Employment Application Employment Application For Commercial Drivers 3025 Jones Mill Rd. Norcross, Ga 30071 Please include current 7 year MVR with this application. Applicant Name Date / / Last, First, Middle In compliance with

More information

Alcohol & Substance Abuse Information. Please complete the following six pages. Sign all forms where highlighted in yellow

Alcohol & Substance Abuse Information. Please complete the following six pages. Sign all forms where highlighted in yellow 11060 County Road 3 (Box 164) South Mountain, Ontario K0E 1W0 1-800-387-0504 www.jedexpress.com Alcohol & Substance Abuse Information Please complete the following six pages. Sign all forms where highlighted

More information

Kunshek Chat & Coal, Inc. 304 Memorial Dr. Pittsburg, KS * Fax

Kunshek Chat & Coal, Inc. 304 Memorial Dr. Pittsburg, KS * Fax ONLINE APPLICATION Kunshek Chat & Coal, Inc. 304 Memorial Dr. Pittsburg, KS 66762 620-231-7280 * 620-231-6247 Fax DRIVER APPLICATION Name: Social Security #: Current Address: Date of Birth: City: State:

More information

Driver's Application For Employment

Driver's Application For Employment Driver's Application For Employment Aviation Express, Inc 3050 E Hwy 316, Citra, FL 32113 Applicant s Full Name In compliance with Federal and State equal employment opportunities laws, we do not discriminate

More information

COMMERCIAL DRIVER APPLICATION

COMMERCIAL DRIVER APPLICATION Date: COMMERCIAL DRIVER APPLICATION Professional Transportation Services, Inc PO Box 2368 541-826-7645 tel 541-826-8921 fax Name: First Middle Last Address Home telephone: City State Zip Cellular telephone:

More information

DRIVER S APPLICATION FOR EMPLOYMENT

DRIVER S APPLICATION FOR EMPLOYMENT DRIVER S APPLICATION FOR EMPLOYMENT Applicant Name Date of Application (Print) Company: J7 TRUCKING, LLC Address: 5515 E Hwy 67 City: Alvarado TX 76009 PH: (817) 761-7077 FAX: (817) 761-7144 In compliance

More information

STORER COACHWAYS DRIVER APPLICATION FOR EMPLOYMENT

STORER COACHWAYS DRIVER APPLICATION FOR EMPLOYMENT STORER COACHWAYS DRIVER APPLICATION FOR EMPLOYMENT Applicant Name Date of Application I am applying for the position of driver at the following location(s) (check all that apply): 3519 McDonald Ave, Modesto,

More information

APPLICATION FOR EMPLOYMENT Contact Recruiting at Fax

APPLICATION FOR EMPLOYMENT   Contact Recruiting at Fax APPLICATION FOR EMPLOYMENT www.kurtztrucking.com Contact Recruiting at 800-265-2835 Fax 519-836-9396 Brian Kurtz Trucking is an Equal Opportunity Employer, Qualified applicants will be considered for all

More information

Thank you for your interest in applying for employment with Clarke Road Transport

Thank you for your interest in applying for employment with Clarke Road Transport COMPANY DRIVER APPLICATION Dear Applicant: Thank you for your interest in applying for employment with Clarke Road Transport The following forms are enclosed: Application for hire Request for Information

More information

Returning Sales Reps and Returning Helper Drivers

Returning Sales Reps and Returning Helper Drivers Returning Sales Reps and Returning Helper Drivers 1. Certification of Violations/ Annual Review of Driving Record 2. MVR Release/Request Form 3. Certificate of Compliance 4. Driver Certificate of Other

More information

Independent Contractor Driver Application

Independent Contractor Driver Application Independent Contractor Driver Application ` Parminder S. Bhullar Director 7825 Terri Drive Westland, Mi. 48185 Tel. 734 474 7703 Fax. 734 446 0324 pinder@betlogistics.us www.betlogistics.us INDEPENDENT

More information

DRIVER QUALIFICATION FILE CHECKLIST

DRIVER QUALIFICATION FILE CHECKLIST DRIVER QUALIFICATION FILE CHECKLIST 1. DRIVER APPLICATION FOR EMPLOYMENT 391.21 2. INQUIRY TO PREVIOUS EMPLOYERS (3 YEARS) 391.23(a)(2) & (c) 3. INQUIRY TO STATE AGENCIES 391.23(a)(1) & (b) 4. MEDICAL

More information

DRIVER APPLICATION FOR EMPLOYMENT

DRIVER APPLICATION FOR EMPLOYMENT DRIVER APPLICATION FOR EMPLOYMENT Applicant Name Date of Application I am applying for the following position(s) (check all that applies): Charter Driver Storer Coachways, 3519 McDonald Ave, Modesto, CA

More information

Applicant Information

Applicant Information Stage 1 Driving Position DRIVER EMPLOYMENT APPLICATION Applications are considered without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job-related

More information

DOT EMPLOYMENT APPLICATION (49CFR ) Answer ALL questions please print

DOT EMPLOYMENT APPLICATION (49CFR ) Answer ALL questions please print DOT EMPLOYMENT APPLICATION (49CFR 391.21) Answer ALL questions please print Gore Nitrogen Pumping Service LLC P.O. Box 65 Seiling OK 73663 We are an Equal Opportunity Employer that does not discriminate

More information

Drivers Application for Employment and Qualification Hanson Trucking, Inc. 251 Truck Rt. Columbia Falls, MT

Drivers Application for Employment and Qualification Hanson Trucking, Inc. 251 Truck Rt. Columbia Falls, MT Drivers Application for Employment and Qualification Hanson Trucking, Inc. 251 Truck Rt. Columbia Falls, MT Employment at Hanson Trucking, Inc. is not guaranteed by submitting this application for employment-qualification.

More information

DRIVER S EMPLOYMENT APPLICATION

DRIVER S EMPLOYMENT APPLICATION DRIVER S EMPLOYMENT APPLICATION Applicant Date of Application: PO Box 5126 Phone (209) 948-4061 Stockton, CA 95205 Fax (209) 547-1109 Website www.reevetrucking.com In compliance with Federal & State Equal

More information

APPLICATION FOR DRIVER S QUALIFICATION

APPLICATION FOR DRIVER S QUALIFICATION F-1.04.01 APPLICATION FOR DRIVER S QUALIFICATION 1 APPLICATION FOR DRIVER S QUALIFICATION Liquid Cargo, Inc. P.O. Box 11857, West Palm Beach, FL 33419 Name Date (Please Print) Current : email address:

More information

DRIVER APPLICATION FOR EMPLOYMENT

DRIVER APPLICATION FOR EMPLOYMENT LINQserv, Inc. 1553 Lyell Avenue, Rochester, NY 14606 Website: LINQserv.com Office: 585.723.1322 Fax: 585.723.8318 DRIVER APPLICATION FOR EMPLOYMENT (First) (Middle) (Maiden Name, if any) (Last) (Street)

More information

DTW Transport LLC Driver s Employment Application

DTW Transport LLC Driver s Employment Application DTW Transport LLC Driver s Employment Application Date of Application: Date of Hire: Name Current Address Phone How Long Previous Address 1 Previous Address 2 Previous Address 3 How Long How Long How Long

More information

DRIVER S EMPLOYMENT APPLICATION An Equal Opportunity Employer

DRIVER S EMPLOYMENT APPLICATION An Equal Opportunity Employer DeLco Transport / The DeLong Co., PO Box 552 Clinton WI 53525 DRIVER S EMPLOYMENT APPLICATION An Equal Opportunity Employer PERSONAL INFORMATION (PLEASE PRINT) NAME (PRINT) Last First Middle PHONE NO.

More information

DRIVER HIRING & QUALIFICATION RECORDS CHECKLIST

DRIVER HIRING & QUALIFICATION RECORDS CHECKLIST FOR OFFICE USE ONLY DRIVER HIRING & QUALIFICATION RECORDS CHECKLIST DRIVER S NAME: DATE OF HIRE/LEASE: Completion Date Initials 1. APPLICATION a) Completed b) Signed c) Dated 2. COPY OF CDL Expiration

More information

YES NO 1. Do you have a Valid Class A CDL Texas Drivers License? 2. Have you ever been cited for reckless driving?

YES NO 1. Do you have a Valid Class A CDL Texas Drivers License? 2. Have you ever been cited for reckless driving? DRIVER PRELIMINARY QUALIFICATION SHEET DRIVER S NAME: YES NO 1. Do you have a Valid Class A CDL Texas Drivers License? 2. Have you ever been cited for reckless driving? 3. Have you ever been arrested for

More information

DRIVER NEW HIRE PROCEDURES

DRIVER NEW HIRE PROCEDURES DRIVER NEW HIRE PROCEDURES 1. Provide the CDL driver a substance testing Chain of Custody testing form and have the driver submit to a pre-employment controlled substances test. The test results will be

More information

CSC Transportation LLC Job Description Semi Tractor-Trailer Driver

CSC Transportation LLC Job Description Semi Tractor-Trailer Driver CSC Transportation LLC Job Description Semi Tractor-Trailer Driver Job Title: Driver of Semi Tractor-Trailer Terminal Reports to: Terminal Manager/Dispatcher/Operations Supervisor General Duties: Pick

More information

EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION EMPLOYMENT APPLICATION Classic Towing is an equal opportunity employer and as required by law does not discriminate in employment on the basis of race, sex, religion, or age. This application will be given

More information

SANTA ROSA TELEPHONE COOPERATIVE, INC HWY 287 EAST P.O. BOX 2128 VERNON, TX 76385

SANTA ROSA TELEPHONE COOPERATIVE, INC HWY 287 EAST P.O. BOX 2128 VERNON, TX 76385 SANTA ROSA TELEPHONE COOPERATIVE, INC. 7110 HWY 287 EAST P.O. BOX 2128 VERNON, TX 76385 HR USE ONLY EMPLOYEE NO. DATE EMPLOYED APPLICANT MUST COMPLETE ALL INFORMATION REQUESTED PLEASE PRINT In compliance

More information

PO BOX OKC, OK PHONE: FAX: Driver Application

PO BOX OKC, OK PHONE: FAX: Driver Application PO BOX 720899 OKC, OK 73172 : 405-373-4999 FAX: 405-722-2575 Driver Application DRIVER INFORMATION FOR NEW APPLICANT: All applicants for a driving position must fill out an application for employment.

More information

NOTE - You will need COMPLETE previous employment address and contact information for a minimum of 3 years of past employment.

NOTE - You will need COMPLETE previous employment address and contact information for a minimum of 3 years of past employment. THANK YOU FOR TAKING THE TIME TO COMPLETE AN EXPRESS APP FOR BLACKROCK LOGISTICS BY TAKING THE TIME TO COMPLETE ALL THE REQUIRED INFORMATION, YOU WILL EXPEDITE THE PROCESS OF HAVING YOUR APPLICATION CONSIDERED

More information

DRIVER S APPLICATION

DRIVER S APPLICATION DRIVER S APPLICATION SUMMITT TRUCKING, LLC 1800 PROGRESS WAY PH: 866-333-5333 CLARKSVILLE, IN 47129 FAX: 866-999-4499 www.summitt.com Date of Application ANSWER ALL QUESTIONS PLEASE PRINT Position Applied

More information

Application for Drivers. Your application for JED Express Ltd must include the following five items

Application for Drivers. Your application for JED Express Ltd must include the following five items 11060 County Road 3 (Box 164) South Mountain, Ontario K0E 1W0 1-800-387-0504 www.jedexpress.com Application for Drivers Your application for JED Express Ltd must include the following five items 1. Completed

More information

DRIVER APPLICATION. You must answer every question. If a question does not apply to you, answer with Not Applicable (N/A).

DRIVER APPLICATION. You must answer every question. If a question does not apply to you, answer with Not Applicable (N/A). Midwest Companies 275 Sola Drive, Gilberts, IL 60136 P: 847-426-6354/F: 847-426-0146 www.mwcompanies.com DRIVER APPLICATION You must answer every question. If a question does not apply to you, answer with

More information

DRIVER EMPLOYMENT APPLICATION Flowerwood Management Inc. (d/b/a/ Flowerwood Trucking) Kelly Road Loxley, AL 36551

DRIVER EMPLOYMENT APPLICATION Flowerwood Management Inc. (d/b/a/ Flowerwood Trucking) Kelly Road Loxley, AL 36551 DRIVER EMPLOYMENT APPLICATION Flowerwood Management Inc. (d/b/a/ Flowerwood Trucking) 15315 Kelly Road Loxley, AL 36551 (Answer all questions. Fill in all shaded areas Please PRINT) In compliance with

More information

ERDNER BROS. INC. MOTOR FREIGHT TRANSPORTATION P.O. Box 68 Swedesboro, NJ PHONE: (856) FAX: (856) Employment Opportunities

ERDNER BROS. INC. MOTOR FREIGHT TRANSPORTATION P.O. Box 68 Swedesboro, NJ PHONE: (856) FAX: (856) Employment Opportunities MOTOR FREIGHT TRANSPORTATION P.O. Box 68 Swedesboro, NJ 08085 PHONE: (856)467-0900 FAX: (856)467-5593 Employment Opportunities WE OFFER APPROXIMATLY 30% OF LINE HAUL REVENUE (LANE AND CUSTOMER VARY) UNLOADING

More information

CDL Driver Application

CDL Driver Application MC621 US DOT 049922 Please type or print clearly. APPLICANT NAME: P.O. Box 1302, East Greenwich, RI 02818-0998 800-343-3500 / 401-589-2461 (fax) / nrayhill@arpin.com CDL Driver Application Date of Application:

More information

FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT

FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT Company Narne FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT In accordance with the provisions of Section 604(b)(2)(A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit

More information

Employment Record: Note: DOT requires employment for 3 years previous and/or commercial driving experience for past 10 years be shown.

Employment Record: Note: DOT requires employment for 3 years previous and/or commercial driving experience for past 10 years be shown. Accident record for past 3 years: Description # of Injuries / Fatalities Traffic convictions & forfeitures for past 3 years: Location Date Charge Penalty Employment Record: Note: DOT requires employment

More information

EMPLOYMENT APPLICATION FORM TURK ENTERPRISES LTD.

EMPLOYMENT APPLICATION FORM TURK ENTERPRISES LTD. EMPLOYMENT APPLICATION FORM TURK ENTERPRISES LTD. Application Date: / / Month Day Year Full Name: First Middle Last Current Address: Street City, Province Postal Code How Long? Previous Address: (If less

More information

APPLICATION FOR DRIVER QUALIFICATION

APPLICATION FOR DRIVER QUALIFICATION Motor Carrier: I. GENERAL APPLICATION FOR DRIVER QUALIFICATION AS REQUIRED BY SECTION 391 - D.O.T. SAFETY REGULATIONS Applicants are considered for positions without regard to race, color, creed, age,

More information

Driver Qualification Application

Driver Qualification Application Driver Qualification Application GENOX Transportation, Inc. 2000 Old Underwood Road La Porte, TX 77571 Telephone: (281) 479-0338; FAX: (281) 479-0663 The Civil Rights Act of 1964 prohibits discrimination

More information

FL TRANSPORT & HOTSHOTS LLC, 100 Los Ranchos Rd NW, Albuquerque, NM APPLICATION FOR EMPLOYMENT

FL TRANSPORT & HOTSHOTS LLC, 100 Los Ranchos Rd NW, Albuquerque, NM APPLICATION FOR EMPLOYMENT APPLICATION FOR EMPLOYMENT (First) (Middle) (Maiden name, if any) (Last): Contact Phone: Address (Street) (City) (State/Zip): # Years at this Address: Social Security #: Date of Birth: Previous Three Years

More information

DRIVER S APPLICATION FOR EMPLOYMENT

DRIVER S APPLICATION FOR EMPLOYMENT Commercial Motor Vehicle Carrier MILO TRANSPORTATION INC. USDOT # 2416605, Indiana DRIVER S APPLICATION FOR EMPLOYMENT Applicant Name: : Company: Milo Transportation, Inc. Address: 525 S. Colfax Suite

More information

DRIVERS. John H. Kooy Trucking, Inc. is looking for qualified drivers with at least two years of trucking experience.

DRIVERS. John H. Kooy Trucking, Inc. is looking for qualified drivers with at least two years of trucking experience. DRIVERS John H. Kooy Trucking, Inc. is looking for qualified drivers with at least two years of trucking experience. John H. Kooy Trucking, Inc. was established in 1971. We are located in Arlington Washington

More information

HOW LONG? FOR. YEARS In case of emergency, please contact: Phone#( )

HOW LONG? FOR. YEARS In case of emergency, please contact: Phone#( ) In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered without regard to race, color, religion, sex, national origin, age, marital status, or non-job

More information

Driver s Application for Employment DQF 100

Driver s Application for Employment DQF 100 Driver s Application for Employment DQF 00 RGM TRANSPORT LLC 03 E Main Ave Myerstown, PA 7067 In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered

More information

DRIVER'S APPLICATION FOR EMPLOYMENT

DRIVER'S APPLICATION FOR EMPLOYMENT DRIVER'S APPLICATION FOR EMPLOYMENT Applicant Name (print) Company CHARTER VANS INC. Date of Application ----'- Address -=p.:.::o::...=.. ----=B:...::o::..::x~::..9.::::0...:::0:...::3:...::5~ City ~ ;:D:...;a:::"Y.L...::tc..:oc..:n~

More information

711. USE OF VEHICLES ON SCHOOL BUSINESS

711. USE OF VEHICLES ON SCHOOL BUSINESS 711. USE OF VEHICLES ON SCHOOL BUSINESS The District recognizes the importance of enforcing the highest standards in connection with the use of personal and District vehicles. Employees performing assigned

More information

The Road to Safety and Compliance Starts with You! ISRI DOT Self-Audit Checklist

The Road to Safety and Compliance Starts with You! ISRI DOT Self-Audit Checklist The Road to Safety and Compliance Starts with You! ISRI DOT Self-Audit Checklist ISRI DOT Self-Audit Checklist Disclaimer: The material herein is for informational purposes on and is provided on an as-is

More information

SERVICES TO BE PERFORMED APPLICANT AUTHORIZATION. Phone: Fax:

SERVICES TO BE PERFORMED APPLICANT AUTHORIZATION. Phone: Fax: SERVICES TO BE PERFORMED This section should be completed by the Employer Please indicate below which background checks you wish to have Foley Carrier Services LLC. perform: Safety Performance History

More information

OWNER OPERATOR PROFILE FOR SERVICES

OWNER OPERATOR PROFILE FOR SERVICES Page 1 of 4 Date: Vehicle Type Date Available to Start Orientation Personal Information Last Name Given Name Middle Name Street Address City Province Home Phone # Business Phone # Postal Code Previous

More information

Class A Tanker Driver

Class A Tanker Driver Class A Tanker Driver REPORTS TO: Transportation Manager / Dispatcher DEFINITION Working with a minimum of direction and supervision. Required to, but not limited to perform the following: RESPONSIBILITIES

More information

PSATS CDL PROGRAM CMV/CDL DRIVER QUALIFICATION FILES (DQF)

PSATS CDL PROGRAM CMV/CDL DRIVER QUALIFICATION FILES (DQF) PSATS CDL PROGRAM CMV/CDL DRIVER QUALIFICATION FILES (DQF) Pennsylvania s intrastate commercial motor vehicle regulations (67 Pa. Code Chapter 231) now provide even more flexibility for local governments

More information

Minimum Training Requirements for Entry-Level CDL Drivers 49 CFR 380

Minimum Training Requirements for Entry-Level CDL Drivers 49 CFR 380 Minimum Training Requirements for Entry-Level CDL Drivers 49 CFR 380 380.500 - Compliance Dates Effective Date of Compliance July 20, 2004 Employers must ensure that entry level drivers who first began

More information

Section 12: Record Keeping Requirements. Minnesota Trucking Regulations

Section 12: Record Keeping Requirements. Minnesota Trucking Regulations Section 12: Record Keeping Requirements Minnesota Trucking Regulations 89 Section 12 Record Keeping Requirements 49 CFR Part 390 Motor carriers who are subject to the Federal Motor Carrier Safety Regulations

More information

SELF-CERTIFICATION/MEDICAL EXAMINER S CERTIFICATION FACT SHEET

SELF-CERTIFICATION/MEDICAL EXAMINER S CERTIFICATION FACT SHEET April 2017 SELF-CERTIFICATION/MEDICAL EXAMINER S CERTIFICATION FACT SHEET As part of the Motor Carrier Safety Improvement Act, the Federal Motor Carrier Safety Administration (FMCSA) amended the Federal

More information

Bee Line Transportation

Bee Line Transportation Bee Line Transportation Employment Application Part 1, page 1 of 8 Date of Application Position applying for. m Bus Driver m Bus Monitor m Dispatcher m Bus Washer m Other Name Last First MI Social Security

More information

APPLICATION FOR EMPLOYMENT OF C.M.V. DRIVERS

APPLICATION FOR EMPLOYMENT OF C.M.V. DRIVERS APPLICATION FOR EMPLOYMENT OF C.M.V. DRIVERS Company Name: ForZack Inc. Street Address: 928 TODD DR. SUITE 2 City, State, Zip Code Janesville, Wl.5-35.4_6, Date: Name. First Middle Last PhoneL_) --------

More information

How to Prepare for a DOT Audit

How to Prepare for a DOT Audit How to Prepare for a DOT Audit The DOT has just informed you that your transportation operation will be audited. Are you prepared? Do you know what records will be reviewed? Do you comply with the regulations?

More information

Risk Control at United Fire Group

Risk Control at United Fire Group United Fire Group (UFG) believes the safety of the employee, public and the operations of a company is essential and every attempt must be made to reduce the possibility of accidents. The safety of the

More information

New Entrants Safety Education Seminar for Georgia Motor Carriers CHAPTER 4

New Entrants Safety Education Seminar for Georgia Motor Carriers CHAPTER 4 New Entrants Safety Education Seminar for Georgia Motor Carriers CHAPTER 4 Chapter 4 GENERAL REQUIREMENTS REVIEW REFERENCE Part 390 Federal Motor Carrier Safety Regulations http://www.fmcsa.dot.gov/rulesregs/fmcsr/regs/390.htm

More information

John M. Seidl - (262) DOT Consultant & Insurance Agent

John M. Seidl - (262) DOT Consultant & Insurance Agent John M. Seidl - (262) 672-0986 DOT Consultant & Insurance Agent Drug and Alcohol Clearinghouse Agenda History FMCSA Safety Management Cycle Why is this important? Regulation Overview Drug and Alcohol Clearinghouse

More information

New Sales Reps and New Helper Drivers

New Sales Reps and New Helper Drivers New Sales Reps and New Helper Drivers 1. Certification of Violations/Annual Review of Driving Record 2. MVR Release/Request Form 3. Certificate of Compliance 4. Driver Certificate of Other Compensated

More information